June 2012: Expertise and Simulation

How Can Educators Use Simulation Applications to Teach and Assess Surgical Judgment? Andersen DK. Academic Medicine, 2012; 87; 7: 934-941.

Our patients rely on the expertise of our faculty. Expert judgment in clinical decision-making is also valuable for our learners to observe because, short of role modeling, this judgment cannot be taught…or can it? In this article, the author explores some characteristics of expertise and judgment, uncovering themes that can be applied to all specialties, in an effort to develop a teaching plan through simulation. He writes:

“An inherent part of expert judgment, therefore, appears to be the transition from routine, automated processes to focused, analytic behavior, characterized by slowing down at critical decision points [by being aware of the ‘subtle complexities of situations’]. Slowing down allows the expert surgeon to engage in analysis, teaching, and self-reflection, which enhances patient safety.” (p. 935). 

After unraveling the concepts of expertise and expert judgment, the author synthesizes literature to present simulation methods that can be used to teach and assess these concepts, including the cognitive skills associated with expert judgment and decision-making. In fact, some of this work with simulation and judgment is already being conducted at Baystate as it continues to evolve in the literature. Similar themes that appear in the literature around this topic include the concepts of cognitive rehearsal of the event prior to performance and strategies to avoid common cognitive errors in clinical decision-making.

Bottom Line:

“…Expert judgment is teachable and transferable to trainees…” (p. 939). Simulation methods provide the environment and tools to teach and assess cognitive and technical aspects of expertise and expert judgment in clinical decision-making.